A Houston cardiovascular surgeon has become the first physician in Texas to perform a robotic-assisted thoracic Heller myotomy to treat achalasia. The procedure was done on Dec. 29, 2006, at Memorial Hermann Memorial City using the da Vinci® Surgical System.

A disorder of the esophagus characterized by a progressive inability to swallow solids and liquids, achalasia is relatively rare, affecting five in every 100,000 adults nationwide. But for those with the disorder, the effects are devastating, including vomiting, weight loss, dehydration and malnutrition.

Former Memorial Hermann patient Ronald Vick developed difficulty swallowing that worsened over a period of 10 months. As the disorder progressed, the muscles in Vick's esophagus weakened until his lower esophageal sphincter failed to open completely, causing food and liquids to remain lodged in his esophagus.

"It was uncomfortable and eventually, it starts wearing on your mind," Vick said. "You're at work and you go out to lunch with friends, and something gets stuck. You start salivating, and everyone asks if you're okay but you're not. You have no choice but to spit the food out."

The new procedure was performed by Miguel Gomez, M.D., who has previously performed two or three Heller myotomies each year using a thoracic approach.

"While the procedure can be performed through the abdomen, my preferred approach is through the chest," Gomez says. "Approaching the esophagus through the chest wall allows you do a more substantial myotomy with far better results."

Prior to using the da Vinci robot for the Heller myotomy, Gomez performed the procedure thoroscopically by inserting long hand-held instruments through a small incision in the chest wall. The robotic-assisted procedure, which is performed through 5 keyhole ports, allows for enhanced visualization, greater precision and a shorter surgery, with a reduction of operating time from approximately 4 to 2 hours.

"The visualization capabilities of the da Vinci allow you to clearly see every muscle fiber you cut during the surgical approach to the submucosa," Gomez said. "You want to reach the submucosa, the layer of loose connective tissue that underlies the muscles and muscosa, but leave it intact. That's when you know you've done an adequate myotomy."

The thoracic approach also benefits patients with scar tissue from previous abdominal surgeries, who would not normally be candidates for a laparoscopic abdominal myotomy.

Following an overnight stay in the hospital, Vick was released with instructions to remain on a soft diet for 4 weeks after surgery.

"I'm a changed man," he said. "After 10 months of progressively worse problems, I was apprehensive about taking my first bite of food after the surgery, but it just went straight down. It's the greatest thing I've ever experienced.